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Mr-Sleepy-Oak
 
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Buying supplies through insurance vs cpap.com

Postby Mr-Sleepy-Oak on Tue May 16, 2017 5:46 am

Hi! I need to buy some supplies for my cpap and I'm wondering what the average price is to purchase the following through insurance. Any idea? (I generally buy direct through cpap.com - love the service by the way -- but wonder if I'm wasting money). My understanding is that generally insurance charges more for the same item so I need to calculate whether my cost sharing makes the item more expensive given the higher price.

- heated humidifier hose
- p10 nasal pillow mask
- p10 headgear
- humifier

By the way, I bought my CPAP machine myself. If I start to get supplies through insurance will they want to track my usage of the CPAP? I'm around 98% compliant but I don't like big brother.

Julie
 
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Re: Buying supplies through insurance vs cpap.com

Postby Julie on Tue May 16, 2017 6:13 am

You must talk to your insurance co. directly to find out what they cover for you.

Cpap.com may accept that insurance, but you need to contact them as well... they host this forum to help people on Cpap but have a separate website.

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Pugsy
 
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Re: Buying supplies through insurance vs cpap.com

Postby Pugsy on Tue May 16, 2017 6:44 am

Almost always using insurance is going to be the cheapest way to go as long as any deductibles have been met and all you are paying out of pocket is co pays.

I don't remember the exact break down for my P10 but it was around $30 total. It was broken down into mask and headgear separately as they always do but it was something like 23 for mask and 7 for headgear that was my part to pay.
Now I don't know if your insurance ends up paying like mine does (mine is Medicare) so I don't know if your co pays would be based off the same allowable amount or not.

I don't know if your insurance would require any sort of proof of compliance before paying for masks and other stuff like that.
Mine doesn't...I have Medicare but I bought my machine privately but I do use a DME for masks and get my one mask every 6 months.
I have never had to prove any sort of compliance to get my masks. Your question about that detail probably should be asked directly to your insurance company.

I just bought a mask from cpap.com. They don't file insurance but will furnish me with a form to file insurance if I wanted one but my insurance won't pay me back so I don't bother. Now your insurance might pay you back...but again you need to ask your insurance what they would do about things bought out of network.
I paid $89 for the mask. My DME doesn't have it yet and no clue when they will get it. It's new to the market. I didn't want to wait.
So I paid the $89 and got the mask now. It was worth it to me to have it now instead of 3 months from now and I avoided the "hassle" factor which isn't a huge factor but a factor nonetheless.
So I paid $60 more for it than I would have paid the DME for it in my co pay.

Don't forget about deductibles...I don't have deductibles on cpap stuff but I don't normally have enough other medical costs to make any deductibles of any size if I did have deductibles. If I did have even a $500 deductible it is unlikely that I would meet that amount in a calendar year with other medical expenses and since I normally just buy a couple masks a year anyway...it's still cheaper to buy from cpap.com than to pay towards the deductible fulfillment.

For exact amounts you have to check with your insurance company as all companies might have different pay schedules or even different fee schedules within different plans.

I have zero idea about the humidifier fees...sorry. Never bought one using insurance.
If you can get the HCPCS billing code to your insurance company they might be willing to tell you what they allow.

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Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Backups..AirCurve 10 ST, S9 Adapt, PR S1 Bipap #760

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sc0ttt
 
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Re: Buying supplies through insurance vs cpap.com

Postby sc0ttt on Tue May 16, 2017 2:28 pm

Image

Your mileage may vary, of course. This was from 2014. $400 of my share was the deductible, insurance paid 80% of the rest. If I'd already met the deductible on other stuff, my total cost would've been $156

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: PR System One 50 Series Heated Humidifier
Additional Comments: 14-cm wg, Model 460, Serial Number: P10175579 4E22 SleepyHead v0.9.6 (testing)
Last edited by sc0ttt on Thu May 18, 2017 2:23 pm, edited 1 time in total.

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Janknitz
 
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Re: Buying supplies through insurance vs cpap.com

Postby Janknitz on Tue May 16, 2017 6:39 pm

Each insurance plan is different, so you need to ask. But it's not as straightforward as you might think. You need to know several pieces of information to make a comparison:
1. Do you have any co-pays or unmet deductibles with your insurance provider. Count those in.
2. What is your insurer's contracted price for each item? Your insurer may or may not tell you this exactly. Instead, they may tell you they pay a percentage (typically 80%) but it's usually NOT a percentage of the fantasy retail price your DME charges, it's 80% of a contracted price with each individual DME. That's usually a much smaller price than the fantasy retail price. But it may be very hard to find out what it is.
3. Keep in mind that by contract for most insurers and by law in most states, the DME cannot charge you more than the contracted price for supplies and equipment. So if the DME's fantasy retail price is $250, but the insurance contracted price is only $100 and the insurance pays 80% or $80, then all you owe in MOST (not all) cases is $20, not $130.

Even if your insurer doesn't pay a cent because a deductible hasn't been met yet, you may still be able to get the insurer's contracted price which may be lower than an online supplier's retail price. Or not. It pays to shop around. And this early in the year, it may make sense to pay toward your deductible so replacements later in the year may cost you little or nothing.

I laugh when politicians say we need to be "good health care consumers" because it is so darn complicated to get the right information and make a carefully considered comparison for something like this when no emergency or urgency exists, how do they expect people to do it in the midst of a health care crisis?
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
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Goofproof
 
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Re: Buying supplies through insurance vs cpap.com

Postby Goofproof on Tue May 16, 2017 9:55 pm

When adding up the different cost factors, don't forget to add in the hassle factor from your INS co. For many of us it makes a difference. Jim

_________________
Mask: ComfortGel Original Nasal CPAP Mask with Headgear
Additional Comments: APAP @15 CM & CMS 50E PULSE OX O2 3L
Maturity is the ability to stick with a job until it's finished; the ability to do a job without being supervised; the ability to carry money without spending it; and the ability to bear an injustice without wanting to get even.

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Janknitz
 
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Re: Buying supplies through insurance vs cpap.com

Postby Janknitz on Tue May 16, 2017 10:00 pm

Goofproof wrote:When adding up the different cost factors, don't forget to add in the hassle factor from your INS co. For many of us it makes a difference. Jim


It's not the insurance companies that are the usual source of hassle, it's usually the DMEs (who like to claim it's the insurer's but it's not).
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

SewTired
 
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Re: Buying supplies through insurance vs cpap.com

Postby SewTired on Thu May 18, 2017 9:52 pm

I'm on Medicare and have both 'insurance' paid for supplies as well as supplies I purchase elsewhere. It's cheaper and easier for me to have Medicare pay for my go-to every day masks (Dreamwear, Swift), and buy my sometimes masks (Circadiance fabric masks) from cpap.com.

Another thing to check with your insurance company is whether or not supplies are free from the annual deductible. Quite often, while visits to the doctor or hospital require paying your deductible, durable medical equipment and their supplies aren't subject to the deductible - just the copay.
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